| NPI | 1275604308 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATASHA BURGESS President 678-778-5869 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: GA 049877) |
| Additional Taxonomies | 261QP2300X Clinic/Center Primary Care |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2025-03-11 |